Medicaid CARE Act would allow more than 2,000 low-income Illinoisans to access substance abuse treatment each year

CARBONDALE – In the midst of the ongoing heroin and prescription opioid abuse epidemic, U.S. Senator Dick Durbin (D-IL) today discussed legislation he has introduced to expand access to treatment for people who are not receiving the addiction care they need. The Medicaid Coverage for Addiction Recovery Expansion (Medicaid CARE) Act would modify the Medicaid Institutions for Mental Disease (IMD) Exclusion policy—a decades-old Medicaid policy that has had the unintended consequence of limiting treatment for our most at-risk populations. The measure would allow more than 2,000 additional Illinois Medicaid beneficiaries to receive care annually. Currently, less than 12 percent of Illinoisans in need of substance abuse treatment actually receive specialized care.

“Too many substance abuse centers do not qualify for Medicaid because of an outdated understanding of addiction, which restricts access to care. Less than 12 percent of Illinoisans in need of substance abuse treatment actually receive specialized care. That unacceptable treatment rate is hindering our ability to help these individuals turn their lives around and start curtailing this public health epidemic that's feeding on our state's youth,” Durbin said. “That’s why I introduced a bill to change this outdated and ill-advised policy to ensure that patients in need of substance abuse care can get it.”

Currently, the IMD Exclusion prohibits the use of federal Medicaid financing for care provided to most patients in residential mental health and substance use disorder treatment facilities larger than 16 beds. Illinois has 585 residential addiction treatment beds across 15 facilities that are larger than the 16-bed threshold and thus ineligible for Medicaid payments.

In the 1960s, the Medicaid Exclusion provision was enacted with the goal of stopping the institutionalization of mentally ill patients. The Exclusion limits Medicaid reimbursements for facilities specializing in mental health and substance abuse treatment, like Gateway Foundation in Carbondale. Across Gateway Foundation's 10 facilities in Illinois, there are only 88 Medicaid approved beds, yet hundreds of people are waiting multiple weeks for treatment at any given time.

Under the Medicaid CARE Act, residential addiction treatment facilities across the nation and here in Illinois would qualify if they:

Provide substance use disorder treatment services;

Are accredited by a national agency;

Have less than 40 beds; and

Provide services to adults for up to 60 consecutive days

The legislation also establishes a new $50 million youth grant program to fund inpatient substance abuse treatment to Medicaid beneficiaries younger than 21 in underserved, high-risk and rural communities.

Illinois experienced 1,652 overdose deaths in 2014 – a nearly 30 percent increase since 2010. Forty percent of those deaths were associated with heroin. Illinois is ranked number one in the nation for a decline in treatment capacity between 2007 and 2012 – and is now ranked the third worst in the country for state-funded treatment capacity.

Nationally, the number of deaths from heroin overdoses more than tripled since 2010. Yet according to the Substance Abuse and Mental Health Services Administration, less than 12 percent of the 21.5 million Americans suffering with a substance use disorder received specialty treatment in 2014.

Durbin is also a cosponsor of the Comprehensive Addiction and Recovery Act (CARA) which would authorize grants to help states adopt a comprehensive approach to the opiate crisis that involves law enforcement, the criminal justice system, the public health system and the recovery support community. CARA was passed by the Senate ealier this month, but the bill falls short of providing the required funding to implement many of the important programs in the legislation. Prior to final passage of the legislation, the Senate defeated an amendment – supported by Durbin – that would have provided $600 million in supplemental appropriations to fund opioid abuse prevention and treatment programs.